Over the 12 months preceding September 11, the Army’s DiLorenzo Tricare Health Clinic (DTHC) at the Pentagon works to develop its mass casualty (MASCAL) plan. This work will significantly and fortuitously help the clinic when it has to implement the plan in response to the Pentagon attack on 9/11. Major Lorie Brown, the chief nurse at the DTHC, is the chairperson for the DiLorenzo Action Response Team (DART). As she will later recall, over this 12-month period, the DART team works “on developing that [MASCAL] plan, really creating a whole new plan. We sat down and met on numerous occasions with the Air Force clinic [also based in the Pentagon], civilian EMS [Emergency Medical Services], Pentagon and [Department of Defense] hierarchy, DPS [the Defense Protective Service], and with the other civilian medical agencies.” They work through various issues, such as “what would happen in the event of a MASCAL, what each of our roles would be.” The DART team, Brown says, participates “in several large tabletop exercises with these external bodies, to include FEMA [the Federal Emergency Management Agency] and the others I just mentioned. We even did our own internal exercise where we made up the scenario of a plane crashing into the building.” [Office of Medical History, 9/2004, pp. 7] This “internal exercise” is likely a reference to an exercise held by the DTHC in May 2001 (see May 2001). [US Department of Health and Human Services, 7/2002, pp. B17 ] Another exercise Brown participates in over this period is the Pentagon Mass Casualty Exercise in October 2000 (see October 24-26, 2000), which also includes a scenario of a plane hitting the Pentagon. [MDW News Service, 11/3/2000] Brown will later credit this work developing the MASCAL plan as being of great benefit when the Pentagon is hit on 9/11, and the plan is initiated (see Soon after 9:37 a.m. September 11, 2001). She will say: “[O]ur planning truly made such a huge difference on that day. Our commander had the foresight to focus on MASCAL prep and gave us the time and budget to really revamp our old MASCAL plan. I can’t say enough about how critical this was to our success.” [Office of Medical History, 9/2004, pp. 7]

A plane crash is simulated inside the cardboard courtyard of a model Pentagon. [Source: Dennis Ryan, MDW News Service]Pentagon and Arlington County emergency responders assemble in the Office of the Secretary of Defense conference room in the Pentagon for a mass casualty exercise (“MASCAL”). The exercise involves several mock-scenarios. One is of a commercial airliner crashing into the Pentagon and killing 341 people, while two others are a terrorist attack at the Pentagon’s subway stop and a construction accident. The plane crash exercise is conducted using a large-scale model of the Pentagon with a model airplane literally on fire in the central courtyard of the building. An Army medic who participates calls it “a real good scenario and one that could happen easily,” while a fire chief notes: “You have to plan for this. Look at all the air traffic around here.” [MDW News Service, 11/3/2000; Mirror, 5/24/2002; United Press International, 4/22/2004; 9/11 Commission, 7/24/2004, pp. 314]

The Army’s DiLorenzo Tricare Health Clinic (DTHC) and the Air Force Flight Medicine Clinic, both housed within the Pentagon, hold a tabletop exercise along with Arlington County Emergency Medical Services. The scenario practiced for is of an airplane crashing into the Pentagon’s west side—the same side as is impacted in the attack on 9/11. [US Department of Health and Human Services, 7/2002, pp. B17 ; Goldberg et al., 2007, pp. 23 and 107] Reportedly, the purpose of the exercise is “to fine-tune their emergency preparedness.” [US Medicine, 10/2001] According to US Medicine newspaper, the plane in the scenario is a hijacked Boeing 757. [US Medicine, 1/2002] (Flight 77, that targets the Pentagon on 9/11, is a 757. [New York Times, 9/13/2001] ) But a federally funded report on the response to the Pentagon attack says it is a commuter airplane. [US Department of Health and Human Services, 7/2002, pp. B17 ] The Defense Department’s own book about the Pentagon attack says the plane in this exercise is a twin-engine aircraft (757s, like Flight 77, are twin-engine aircraft), but that it crashes into the Pentagon by accident in the scenario. [New York Times, 9/13/2001; Goldberg et al., 2007, pp. 107] The idea of a plane hitting the Pentagon was suggested by Colonel John Baxter, the commander of the Air Force Flight Medicine Clinic, who has often been reminded that the Pentagon is on the flight path of nearby Reagan National Airport. The scenario was approved by Air Force Surgeon General Paul Carlton Jr. [Goldberg et al., 2007, pp. 107 and 109] Baxter and Col. James Geiling, the commander of the DTHC, later say this exercise prepares them well to respond to the Pentagon attack on 9/11. For example, the Air Force Flight Medicine Clinic retools its trauma packs as a result. [US Medicine, 10/2001] And, due to the exercise, staffers of both clinics will wear special blue vests on 9/11 labeled “physician,” “nurse,” or “EMT,” to allow for easy identification. [Uniformed Services University, 1/2002 ] Paul Carlton will say, “We learned a lot from that exercise and applied those lessons to September 11.” [Murphy, 2002, pp. 222] And Major Lorie Brown, the chief nurse of the DTHC, who leads the exercise, will later recall, “The training made a huge difference” on 9/11. [Nursing Spectrum, 9/24/2001] The two Pentagon clinics routinely hold mass casualty tabletop exercises. The scenario changes for each drill. [Goldberg et al., 2007, pp. 107]

A mass casualty exercise, involving a practice evacuation, is held at the Pentagon. General Lance Lord, the assistant vice chief of staff of the Air Force who is one of the participants in the exercise, will later recall, “[It was] purely a coincidence, the scenario for that exercise included a plane hitting the building.” Lord will also say that on 9/11, “our assembly points were fresh in our minds” thanks to this practice. [Air Force Space Command News Service, 9/5/2002]

Walter Reed Army Medical Center. [Source: US Army]The Walter Reed Army Medical Center (WRAMC) in Washington, DC suffers a four-day power loss following an electrical transformer fire on August 27. Backup generators ensure patient care is minimally affected, but as a precaution 77 of the hospital’s roughly 100 patients are moved to other facilities until it regains full power. Most go to the National Naval Medical Center (NNMC) in Bethesda. According to Capt. Tom Sizemore, the acting commander of the NNMC, precautionary measures are necessary due to the size of the patient transfer. So on August 28 he sets the hospital into a mass casualty condition. Usually such a condition is only set in response to a major incident with many seriously injured people. Sizemore says, “This most unfortunate opportunity has provided NNMC with a very special opportunity. We were able to exercise our response system, with real patients, but (thank God) not with patients involved in some mass disaster.” [Stripe, 8/31/2001; Bethesda Journal, 9/6/2001; Stripe, 9/6/2001; Office of Medical History, 9/2004, pp. 146] Walter Reed is about six miles from the Pentagon, and its ambulance teams will respond to the attack there on September 11. Many believe that coping with the power failure helps prepare them for this. One member of staff later says, “A lot of the procedures that we used in the September 11 tragedy, we had just come out of this power loss where we had implemented a lot of what we did. We had good procedures in place that we had already just executed. It was really eerie.” [NurseWeek, 9/17/2001; Office of Medical History, 9/2004, pp. 145-146] A similar incident also occurs around this time at DeWitt Army Community Hospital at Fort Belvoir, an army base roughly 12 miles south of the Pentagon. The details of this are unspecified. [Stripe, 9/20/2001] Ambulance teams from DeWitt will also be involved in the emergency response to the Pentagon attack. [Office of Medical History, 9/2004, pp. i]

Major Lorie Brown. [Source: US Medicine]The DiLorenzo Tricare Health Clinic inside the Pentagon has its equipment for dealing with mass casualty (MASCAL) incidents out of storage this morning, because staff members are doing an inventory. Major Lorie Brown, the chief nurse, will need to initiate the clinic’s MASCAL disaster plan after the Pentagon is hit at 9:37 a.m. (see Soon after 9:37 a.m. September 11, 2001). She later says, “So there were many pieces that just fell into place and worked so well on that day. It was just fortuitous. It was just amazing that way that things kind of happened the way they did.” [Nursing Spectrum, 9/24/2001; Office of Medical History, 9/2004, pp. 7]

Medical workers at the first triage area set up outside the Pentagon after it is attacked. [Source: Mark D. Faram / US Navy]Soon after the Pentagon is hit, medical workers initiate their mass casualty plan (MASCAL) for dealing with disasters. Sergeant Matthew Rosenberg, a medic at the Pentagon’s DiLorenzo Tricare Health Clinic, arrives at the center courtyard. Seeing smoke rising from the side of the building and patients staggering out, he radios the clinic: “You need to initiate MASCAL right now! We have mass casualties! I need medical assets to the courtyard!” Major Lorie Brown, chief nurse of the DiLorenzo Clinic, says that as soon as she sees people running down the corridor to evacuate, “we initiated the MASCAL, started galvanizing all of our assets and put our plan in action.” [Washington Post, 9/16/2001; Office of Medical History, 9/2004, pp. 7, 39] The Pentagon has actually conducted at least three MASCAL training exercises in the previous 12 months, based around a plane crashing into the place (see October 24-26, 2000)(see May 2001)(see Early August 2001). Lieutenant Colonel John Felicio, the deputy commander for administration of the DiLorenzo Clinic, says, “The saving grace to our efforts was the two MASCAL exercises we previously had conducted.… Our scenario for both MASCALS was a plane flying into the Pentagon courtyard.” Furthermore, the nearby Walter Reed Army Medical Center (WRAMC), which sends ambulances in response to the attack, has recently recovered from a four-day power loss (see August 27-31, 2001). A military report will later state: “Many believe that [this] extended emergency… helped WRAMC in its response on September 11.” [Office of Medical History, 9/2004, pp. 18, 146]

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